impact story

Automation Helps Organization Identify $1M in Underpayments

Unable to Track Underpayments and Address Unfavorable Variations

For most hospitals, analyzing and modeling their payer reimbursements is a manual process that takes significant time and the work of many analysts. Without access to tools and workflows that automate this process, organizations are unable to accurately track underpayments and address unfavorable variations. When payers propose contract changes for “net neutral” outcomes, organizations often lack the ability to model the true results of those changes.

A children’s hospital in the southeast discovered that their manual, Excel-based validation process for payer rates was not providing optimal results. Their team needed a tool that would allow them to automate their process and identify any inaccuracies in their payer fee schedule. They wanted to go to the negotiation table with a full understanding of the impact of their rates, with the ability to quickly model and review payer performance and margin on an ongoing basis.

This organization drove results and impact

Recovered over half of $1M identified in first year

Reallocated recovered funds to avoid furloughing staff during COVID-19

Empowered team to strengthen future vendor negotiations

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